An Approach to Obstetrical Brachial Plexus Injuries

In obstetric brachial plexus lesions with avulsion injury, nerve grafting for biceps muscle re-innervation may not be possible owing to the unavailability of a proximal stump. In such cases, the intercostal nerves or medial pectoral nerve can serve as donor nerves in an end-to-end transfer to the musculocutaneous nerve. The present study reports the results of both techniques from a single institution in a consecutive series of 42 patients between 1995 and 2008. From 1995 to 2000 we always used the intercostal nerve transfer, and from 2001 to 2008 both techniques were used. Biceps muscle force ≥ Medical Research Council Grade 3 was achieved in 37 of 42 patients after a mean follow-up of 44 months. There was no statistical difference in the results in the medial pectoral nerve transfer group (n = 25) and the intercostal nerve transfer group (n = 17).

Section: Introductionsupporting

confidence: 58%

Intercostal and pectoral nerve transfers to re-innervate the biceps muscle in obstetric brachial plexus lesions

Pondaag

Malessy

2013

“…The active movement scale scores for each of these patients was reviewed to determine which movements were possible at 3 weeks after operation. The AMS is a validated measure of upper limb movement in infants (Al-Qattan et al, 1995;Clarke and Curtis, 1995;Curtis et al, 2002). Initially we investigated which movements were present or absent as this demonstrates simply whether there is a contribution to that movement from T1 or not.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, this situation mimics the anatomical ablative experiments of the 19th century, allowing us to assess patients in whom only the T1 root remains intact and all other root contributions to the plexus have been surgically removed. As part of our protocol (Borschel and Clarke, 2009;Marcus and Clarke, 2003), all patients undergoing such reconstruction are reviewed 3 weeks postoperatively and their active movement scale scores (AMS; Table 2) are recorded, providing an index of the upper limb function (Al-Qattan et al, 1995;Clarke and Curtis, 1995;Curtis et al, 2002). At this early time point it is inconceivable that the reconstructed roots would be contributing to limb movement and any remaining limb function must be due to the function of the T1 root alone.…”

Section: Assessment Of Brachial Plexus Pathology In Adultsmentioning

confidence: 99%

Functional contribution of T1 to the brachial plexus in infants

Fattah

Curtis

Agur

et al. 2011

To determine the contribution of the T1 root to movements of the upper limb in infancy, 40 infants presenting with obstetrical brachial plexus palsy who underwent resection and reconstruction of all brachial plexus roots with the exception of the T1 root were assessed in the early postoperative period. The movements of the limb were recorded using the Hospital for Sick Children active movement scale and demonstrated considerable variability. All movements of the upper limb were observed in this group with the exception of external rotation of the shoulder and elbow flexion. Classical accounts of the function of T1 have limited its activity to the small muscles of the hand and were based on anatomical dissection, brachial plexus injuries and electrical stimulation. By contrast, this study isolated the physiological activity of T1 and analysed the functional contribution of this root to arm movement. We show a greater than generally recognized contribution of T1 to the function of the upper limb in infants.

“…Obstetric brachial plexus injury (OBPI) affects between 1 to 2.6 per 1000 live births (Abzug and Kozin, 2010;Greenwald et al, 1984;Levine et al, 1984). Many different patterns of injuries exist and their treatment is complex (Clarke and Curtis, 1995;Marcus and Clarke, 2003). An injury to the upper trunk (C5, 6) of the brachial plexus is the most common OBPI, with an incidence ranging between 40% and 91% of all obstetrical plexus injuries (Bennet and Harrold, 1976;Greenwald et al, 1984).…”

Section: Introductionmentioning

confidence: 99%

Isolated C5–C6 avulsion in obstetric brachial plexus palsy treated by ipsilateral C7 neurotization to the upper trunk: outcomes at a mean follow-up of 9 years

Gibon

Romaña

Vialle

et al. 2015

Cervical root avulsions are the worst pattern of injury in obstetrical brachial plexus injury (OBPI). The prognosis is poor and the treatment is mainly surgical with extraplexual neurotizations or muscle transfers. We present the outcomes of a technique performed in our institution to treat C5-C6 avulsion in obstetrical brachial plexus injury. This technique consists of a total ipsilateral C7 neurotization to the upper trunk. Ten babies with isolated C5-C6 root avulsion were operated on; we were able to review nine of them at over 12 months follow-up. The shoulder and the elbow function were assessed, as well as the Mallet Score. The mean follow-up was 9.2 years (SD 5.7). After a follow-up of 6 years, elbow flexion was restored with a range of motion ⩾130° and a motor function ⩾M3 in all patients. The average Mallet score was 18.1 (SD 1.2). This approach appears to be a viable alternative to extraplexual neurotizations for the treatment of C5-C6 nerve root avulsion.